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OBJECTIVES
� Appropriate trauma room radiology
� Advantages/disadvantages
� What radiology to do before transfer
FAST
� Detect fluid (blood) in pericardium and/or peritoneum
� Performed by surgeon, ER physician, radiologist
� Well validated for all blunt abdominal trauma and penetrating thoracoabdominal injuries
FAST
Sensitivity of FAST approaches 100% with precordial or transthoracic wounds and with hypotensive patients with blunt abdominal trauma.
CASE
� 29 year old male
� Just “minding his own business”
� Stabbed in epigastrium/xyphoid area
� Initially protecting his airway (verbally abusive) and BP 100mmHg systolic
FAST – Penetrating Precordial Wound
Penetrating Chest Wound
FAST
Positive Equivocal Negative
OR OR (pericardial window)
Further imaging (Echo,CT)
Observation Repeat FAST
FAST – Blunt Abdominal Trauma
Blunt Trauma
FAST
Positive Equivocal Negative
Stable Unstable Stable Unstable Repeat FAST/ further imaging
CT OR CT or DPL OR or DPL
CT SCANS
� External Trauma - high suspicion
� Mechanism of Injury
� Altered LOC – unable to examine
� “Pan Scan” – CT head, C-spine, Chest, Abdomen/Pelvis
WHOLE BODY CT SCAN
Retrospective review of German Trauma Registry (4600 patients, ISS>16)Estimated probability of survival on TRISS, RISC & SMRCompared patients who underwent whole body CT scan vs selected CT scan
Whole body CT scan was an independent predictor for survival (p<0.002)
WHOLE BODY CT SCAN
Compared whole body MSCT as sole radiologic procedure vs conventional radiology, U/S and organ specific CT scan
Time to complete diagnostic workup and move patient to definitive treatment was faster with MSCT
CT SCAN
� Risk of radiation exposure - LHSC experience- mean 3.6 CT scans/trauma patient- mean dose of 28 mSv
� Average background dose of natural radiation is 3 mSv/yr
� Radiation worker’s annual exposure limited to 20 mSv/yr
IMAGING BEFORE TRANSFER
� Must be knowledgeable of your own institution’s capabilities and limitations
� Quickly identify patients that exceed local resources
� Identify high risk patients
� Avoid unnecessary procedures
IMAGING BEFORE TRANSFER
� Manage life threatening injuries and stabilize disabling injuries
� Everyone should have AP chest and FAST (if available) +/- AP pelvis
TO SCAN or NOT TO SCAN???
� Case25 year old male MVC, StableGCS 10Open femur fracturePositive FAST
� Should this patient be scanned prior to transfer?
SUMMARY
� AP chest, pelvis & FAST in Primary Survey
� CT scan excellent test…
� Identify patients quickly that exceed local resources to avoid delay in transfer
� Avoid unnecessary tests if they will not change management